Deficiencies in Nutritional Intake in Patients with Diabetic Foot Ulcers

Authors

  • Haiyan M. Maier Department of Nutrition, Food, and Exercise Sciences, College of Human Science, The Florida State University, Tallahassee, FL, USA
  • Jasminka Ilich Ernst Department of Nutrition, Food, and Exercise Sciences, College of Human Science, The Florida State University, Tallahassee, FL, USA
  • Bahram Arjmandi Department of Nutrition, Food, and Exercise Sciences, College of Human Science, The Florida State University, Tallahassee, FL, USA
  • Jeong Su Kim Department of Nutrition, Food, and Exercise Sciences, College of Human Science, The Florida State University, Tallahassee, FL, USA
  • Maria T. Spicer Department of Nutrition, Food, and Exercise Sciences, College of Human Science, The Florida State University, Tallahassee, FL, USA

DOI:

https://doi.org/10.6000/1929-5634.2016.05.04.1

Keywords:

Diabetes, Diabetic Foot, Wounds, Nutrition, Malnutrition, Protein.

Abstract

Aims: This study examined the dietary and anthropometric components of diabetic patients with or without diabetic foot ulcers (DFU).

Methods: Eighty-two adult subjects were recruited in Tallahassee, FL (USA) and categorized into one of three groups: subjects without diabetes, patients with Diabetes Mellitus (DM) but not foot ulcers, and patients with DFU. Twenty-four hour food recalls, foot ulcer history and blood samples were collected from each subject. Dietary intake was evaluated with Food Processor. Biomarkers of inflammation and oxidative stress were measured with ELISA kits.

Results: DFU subjects in this study were mostly overweight or obese. DFU had inadequate intakes in protein, fiber, vitamin B1, B2, B3, B6, C, D, and E; calcium, magnesium, phosphorus, potassium, selenium, and zinc. They had excessive intakes in saturated fat, trans fat, and sodium.

Conclusions: Malnutrition is very common in the DM and DFU subjects. Protein and vitamin supplementation may be beneficial in prevention and management of DM as well as DFU.

References

CDC. National Diabetes Fact Sheet 2011.

Bloomgarden ZT. American Diabetes Association 60th Scientific Sessions, 2000: the diabetic foot. Diabetes Care 2001; 24(5): 946-51. https://doi.org/10.2337/diacare.24.5.946 DOI: https://doi.org/10.2337/diacare.24.5.946

Moss SE, Klein R, Klein BEK. Long-term incidence of lower-extremity amputations in a diabetic population. Archives of Family Medicine 1996; 5(7): 391-8. https://doi.org/10.1001/archfami.5.7.391 DOI: https://doi.org/10.1001/archfami.5.7.391

Agrawal S, Pandey SS, Shukla VK, Kaur P. Nutritional and vitamin status of non-healing wounds in patients attending a tertiary hospital in India. J Dermatol 2003; 30(2): 98-103. https://doi.org/10.1111/j.1346-8138.2003.tb00355.x DOI: https://doi.org/10.1111/j.1346-8138.2003.tb00355.x

Wong MW, Leung PC, Wong WC. Limb salvage in extensive diabetic foot ulceration-a preliminary clinical study using simple debridement and herbal drinks. Hong Kong Med J 2001; 7(4): 403-7.

Moulik PK, Mtonga R, Gill GV. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care 2003; 26(2): 491-4. https://doi.org/10.2337/diacare.26.2.491 DOI: https://doi.org/10.2337/diacare.26.2.491

Chadwick P, Acton C. The use of amelogenin protein in the treatment of hard-to-heal wounds. Br J Nurs 2009; 18(6): S22, S4, S6, passim. DOI: https://doi.org/10.12968/bjon.2009.18.Sup2.40778

Eldor R, Raz I, Ben Yehuda A, Boulton AJ. New and experimental approaches to treatment of diabetic foot ulcers: a comprehensive review of emerging treatment strategies. Diabet Med 2004; 21(11): 1161-73. https://doi.org/10.1111/j.1464-5491.2004.01358.x DOI: https://doi.org/10.1111/j.1464-5491.2004.01358.x

Steed DL, Webster MW, Ricotta JJ, Luterman A, Brown S, Comerota AJ, et al. Clinical-Evaluation of Recombinant Human Platelet-Derived Growth-Factor for the Treatment of Lower-Extremity Diabetic Ulcers. Journal of Vascular Surgery 1995; 21(1): 71-81. https://doi.org/10.1016/S0741-5214(95)70245-8 DOI: https://doi.org/10.1016/S0741-5214(95)70245-8

Falanga V. Wound healing and its impairment in the diabetic foot. Lancet 2005; 366(9498): 1736-43. https://doi.org/10.1016/S0140-6736(05)67700-8 DOI: https://doi.org/10.1016/S0140-6736(05)67700-8

Cartwright MM. The metabolic response to stress: a case of complex nutrition support management. Crit Care Nurs Clin North Am 2004; 16(4): 467-87. https://doi.org/10.1016/S0899-5885(04)00070-X DOI: https://doi.org/10.1016/S0899-5885(04)00070-X

Shepherd AA. Nutrition for optimum wound healing. Nurs Stand 2003; 18(6): 55-8.

MacKay D, Miller AL. Nutritional support for wound healing. Altern Med Rev 2003; 8(4): 359-77.

Arnold M, Barbul A. Nutrition and wound healing. Plastic and Reconstructive Surgery 2006; 117(7): 42S-58S. https://doi.org/10.1097/01.prs.0000225432.17501.6c DOI: https://doi.org/10.1097/01.prs.0000225432.17501.6c

Brown KL, Phillips TJ. Nutrition and wound healing. Clinics in Dermatology 2010; 28(4): 432-9. https://doi.org/10.1016/j.clindermatol.2010.03.028 DOI: https://doi.org/10.1016/j.clindermatol.2010.03.028

Maritim AC, Sanders RA, Watkins JB. Diabetes, oxidative stress, and antioxidants: A review. Journal of Biochemical and Molecular Toxicology 2003; 17(1): 24-38. https://doi.org/10.1002/jbt.10058 DOI: https://doi.org/10.1002/jbt.10058

Rigalleau V, Barbe M, Garuz F, Baillet-Blanco L, Beauvieux MC, Gin H. Nutritional factors and diabetic foot: a role for vitamin E? Diabet Med 2004; 21(8): 951-2. https://doi.org/10.1111/j.1464-5491.2004.01247.x DOI: https://doi.org/10.1111/j.1464-5491.2004.01247.x

Cohen J. Statistical power analysis for the behavioral sciences. second edition ed. Hillsdale, Newy Jersey1988.

ADA. Choose Your Foods: Exchange Lists for Diabetes. American Diabetes Association and American Dietetic Association 2011.

Maier HM, Ilich JZ, Kim J-S, Levenson CW, Arjmandi BH, Spicer MT. Dietary advanced glycation end-products exacerbate oxidative stress in patients with diabetic foot ulcers. Journal of Diabetes Research and Clinical Metabolism 2014; 3(1). https://doi.org/10.7243/2050-0866-3-2 DOI: https://doi.org/10.7243/2050-0866-3-2

Pannemans DL, Westerterp KR. Energy expenditure, physical activity and basal metabolic rate of elderly subjects. Br J Nutr 1995; 73(4): 571-81. https://doi.org/10.1079/BJN19950059 DOI: https://doi.org/10.1079/BJN19950059

Evans E. Nutritional assessment in chronic wound care. J Wound Ostomy Continence Nurs 2005; 32(5): 317-20. https://doi.org/10.1097/00152192-200509000-00009 DOI: https://doi.org/10.1097/00152192-200509000-00009

Liu S, Serdula M, Janket SJ, Cook NR, Sesso HD, Willett WC, et al. A prospective study of fruit and vegetable intake and the risk of type 2 diabetes in women. Diabetes Care 2004; 27(12): 2993-6. https://doi.org/10.2337/diacare.27.12.2993 DOI: https://doi.org/10.2337/diacare.27.12.2993

Bazzano LA, Li TY, Joshipura KJ, Hu FB. Intake of fruit, vegetables, and fruit juices and risk of diabetes in women. Diabetes Care 2008; 31(7): 1311-7. https://doi.org/10.2337/dc08-0080 DOI: https://doi.org/10.2337/dc08-0080

Pitt S, May K, Colman P, Wraight P. Deficiencies in nutritional intake in patients admitted with diabetes-related foot complications. Nutrition & Dietetics 2007; 64(3): 186-91. https://doi.org/10.1111/j.1747-0080.2007.00096.x DOI: https://doi.org/10.1111/j.1747-0080.2007.00096.x

Shukla A, Rasik AM, Patnaik GK. Depletion of reduced glutathione, ascorbic acid, vitamin E and antioxidant defence enzymes in a healing cutaneous wound. Free Radic Res 1997; 26(2): 93-101. https://doi.org/10.3109/10715769709097788 DOI: https://doi.org/10.3109/10715769709097788

Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007; 92(6): 2017-29. https://doi.org/10.1210/jc.2007-0298 DOI: https://doi.org/10.1210/jc.2007-0298

Via M. The malnutrition of obesity: micronutrient deficiencies that promote diabetes. ISRN Endocrinol 2012; 2012: 103472. https://doi.org/10.5402/2012/103472 DOI: https://doi.org/10.5402/2012/103472

Schwalfenberg GK. A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. Mol Nutr Food Res 2011; 55(1): 96-108. https://doi.org/10.1002/mnfr.201000174 DOI: https://doi.org/10.1002/mnfr.201000174

Lansdown ABG, Mirastschijski U, Stubbs N, Scanlon E, Agren MS. Zinc in wound healing: Theoretical, experimental, and clinical aspects. Wound Repair and Regeneration 2007; 15(1): 2-16. https://doi.org/10.1111/j.1524-475X.2006.00179.x DOI: https://doi.org/10.1111/j.1524-475X.2006.00179.x

Salgueiro MJ, Krebs N, Zubillaga MB, Weill R, Postaire E, Lysionek AE, et al. Zinc and diabetes mellitus: is there a need of zinc supplementation in diabetes mellitus patients? Biol Trace Elem Res 2001; 81(3): 215-28. https://doi.org/10.1385/BTER:81:3:215 DOI: https://doi.org/10.1385/BTER:81:3:215

Wojcik A, Atkins M, Mager DR. Dietary intake in clients with chronic wounds. Can J Diet Pract Res 2011; 72(2): 77-82. https://doi.org/10.3148/72.2.2011.77 DOI: https://doi.org/10.3148/72.2.2011.77

Ekinci EI, Cheong KY, Dobson M, Premaratne E, Finch S, MacIsaac RJ, et al. High sodium and low potassium intake in patients with Type 2 diabetes. Diabetic Medicine 2010; 27(12): 1401-8. https://doi.org/10.1111/j.1464-5491.2010.03111.x DOI: https://doi.org/10.1111/j.1464-5491.2010.03111.x

Fats and Oils: AHA Recommendation [database on the Internet] 2011 [cited 1/20/2013].

Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375(9733): 2215-22. https://doi.org/10.1016/S0140-6736(10)60484-9 DOI: https://doi.org/10.1016/S0140-6736(10)60484-9

Doell D, Folmer D, Lee H, Honigfort M, Carberry S. Updated estimate of trans fat intake by the US population. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2012; 29(6): 861-74. https://doi.org/10.1080/19440049.2012.664570 DOI: https://doi.org/10.1080/19440049.2012.664570

Downloads

Published

2017-01-01

How to Cite

Maier, H. M., Ernst, J. I., Arjmandi, B., Kim, J. S., & Spicer, M. T. (2017). Deficiencies in Nutritional Intake in Patients with Diabetic Foot Ulcers. Journal of Nutritional Therapeutics, 5(4), 85–92. https://doi.org/10.6000/1929-5634.2016.05.04.1

Issue

Section

Articles